Case of the week: Neurology

RE: Case of the week: Neurology

Nicola Cole — Tue, 29 Oct 2019 21:40:43 GMT

[quote user="vs0u "]

[quote user="Nicola M"]I did an in-house Baermann’s-positive for Angiostrongylus larvae.[/quote]

So was lungworm high on your list? Not in a lungworm area and wouldn't have thought of it with these presenting signs!

[/quote]

It was fairly high on the list. It was probably 10years ago but my first neuro presentation of lungworm (which is why I remember it!) I was in an area (Surrey) that was seeing a few cases so any dog with a cough and anything weird was being Baermann’s tested.

Also, because we were on the look out we knew that Wales was a hotbed of it!

RE: Case of the week: Neurology

vs0u — Tue, 29 Oct 2019 19:03:52 GMT

[quote user="Nicola M"]I did an in-house Baermann’s-positive for Angiostrongylus larvae.[/quote]

So was lungworm high on your list? Not in a lungworm area and wouldn't have thought of it with these presenting signs!

RE: Case of the week: Neurology

Anthony Dennison — Tue, 29 Oct 2019 09:38:16 GMT

[quote user="Clive Ansell"]Out of interest, and to keep the thread going, how would folk progress this case with a lack of financial resources, if the signs had not abated and the test for lungworm was negative?[/quote]

Covered with fenbendazole just in case, cage rest and NSAIDs. NOT steroids as their use has been shown to be a negative prognostic indicator in spinal cases.

RE: Case of the week: Neurology

Clive Ansell — Mon, 28 Oct 2019 07:43:21 GMT

Good call, and a great result.

A fine example of a case where there are limited resources available, and common sense and good clinical acumen prevail to win the day. Demonstrates that a lot can be done with very little sometimes.

Guess we will never know whether lungworm was the cause, or whether or not it was coincidental.

I had a similar case about 18 months ago. It was a young adult Boxer that was being treated for Campylobacter presumed from feeding a raw chicken diet, that then presented with very slight and very vague ataxia affecting all limbs, initially put down to general weakness as a result of severe weight loss. collapsed and finished up being referred, where an intracranial haemorrhage was diagnosed due to a coagulopathy, and a positive test for Lungworm. Made a full recovery.

Out of interest, and to keep the thread going, how would folk progress this case with a lack of financial resources, if the signs had not abated and the test for lungworm was negative?

RE: Case of the week: Neurology

Nicola Cole — Sun, 27 Oct 2019 19:38:05 GMT

Finances didn’t stretch to GA X-ray either!

So looking at things we could test for cheaply in house that would change treatment:

I did an in-house Baermann’s-positive for Angiostrongylus larvae.

Treated with Milbemax once weekly for 4 weeks. Pup made a full recovery. So am presuming the signs were caused by lung worm (although I guess I can’t rule out something else that self-resolved and the lungworm could have been an incidental finding at that stage).

P.s. The arachnoid cyst mentioned above sounds far more interesting that this!

RE: Case of the week: Neurology

Clive Ansell — Sun, 27 Oct 2019 18:05:17 GMT

[quote user="Nicola M"]So the (presumed) diagnosis has been mentioned.[/quote]

Go on then, do tell.

what did you do and what did you find?

[quote user="Nicola M"]referral not an option financially (very limited finances)[/quote]

would it stretch to GA or sedation for radiographs?

RE: Case of the week: Neurology

Nicola Cole — Sun, 27 Oct 2019 12:03:29 GMT

So the (presumed) diagnosis has been mentioned.

To answer a few of the questions:

-small to medium sized cross, probably a bit of beagle in there.

-not docked tail.

-microchipped, presumably by previous vets (but didn’t actually check).

-no pyrexia appears systemically well.

-is vaccinated

-referral not an option financially (very limited finances)

-UK born, current owners had for a couple of months after getting from a friend of a friend from Wales.

RE: Case of the week: Neurology

Joyce Whitehead — Sun, 27 Oct 2019 11:57:45 GMT

I would be inclined to go with Clive’s list - a good approach I feel.

To add to the list we have already of differentials I have once seen a similar issue in a dog this age that turned out (diagnosed at referral) to be an arachnoid cyst.

RE: Case of the week: Neurology

Clive Ansell — Sun, 27 Oct 2019 10:32:43 GMT

Has the dog got a normal tail? has it been docked?

Microchipped? by whom?

what breeds does it consist of?

RE: Case of the week: Neurology

Clive Ansell — Sun, 27 Oct 2019 10:05:36 GMT

My primary line of thought takes me to suspecting some of impingement of the Thoracic or Lumbar (although could be higher) spinal cord; which could include IVDD secondary to trauma, a congenital or developmental lesion, or any space occupying lesion such as a haematoma secondary to trauma or a systemic coagulopathy (Warfarin, lungworm) or even ischaemic myopathy.

That said it would not be possible to exclude a higher CNS lesion, disease such as Neospora caninum, or peripheral neuropathy at this stage.

First things first. I would opt for basic baseline blood work, and spinal radiographs to begin with.

With the information given, I would discuss with the client options of

1) Cage rest and time +/- NSAID

2) Basic bloods and spinal rads (my choice)

3) Referral

RE: Case of the week: Neurology

Beats — Sun, 27 Oct 2019 10:03:52 GMT

Lungworm (aberrant migration or bleed from resultant coagulopathy).

RE: Case of the week: Neurology

Lucy Fleming — Sun, 27 Oct 2019 09:42:14 GMT

I'd possibly add discospondylitis to the above list, though would maybe expect it to be unwell. Was it pyrexic at all?

RE: Case of the week: Neurology

Dagmar Steele — Sun, 27 Oct 2019 09:11:41 GMT

So, let's go:

Vascular: Thrombus - highly unlikely, not a cat

fibrocartilagenous embolism - possible, usually they are truly paralized though, rather larger dogs than smaller ones

Inflammatory: we want to know about vaccinations, because - distemper,

apart from that myasthenia gravis, neosporosis, toxoplasmosis, any kind of meningitis

traumatic - history seems to exclude this, although I never fully believe what people tell me

anomalies - what breed? small dog might present with atlanta-axial subluxation or hydrocephalus, or if CKC with syringowhatsit

metabolic - pss

idiopathic - can't think of anything that fits the bill

neoplastic - rather unlikely in a young dog, a zebra I'd only look at if the horses have been ruled out.

degenerative - apart from possible disc herniation I'd expect them more in older dogs

sooo, vcc history pls and size and possible breeds involved in the dog

RE: Case of the week: Neurology

Nicola Cole — Sun, 27 Oct 2019 07:02:55 GMT

[quote user="Clive Ansell"]

Are panniculus reflexes normal, and bilaterally symmetrical?

Is the reduced proprioception symmetrical?

[/quote]

Yes, reduced proprioception symmetrical.

Pannicilus-to be honest I can’t remember . This is a fairly old case, just found it interesting. I’m going to say normal and symmetrical....

RE: Case of the week: Neurology

Clive Ansell — Sun, 27 Oct 2019 06:15:31 GMT

Are panniculus reflexes normal, and bilaterally symmetrical?

Is the reduced proprioception symmetrical?

RE: Case of the week: Neurology

Nicola Cole — Sat, 26 Oct 2019 20:54:26 GMT

-normal mentation, no nystagmus, no head tilt, no cranial nerve deficits, no indication of ear disease.

-neck ROM fine, no neck pain.

-forelimbs completely normal on neuro exam.

-hindlimbs- bilateral sluggish conscious proprioception but present, normal patella reflexes, intact deep pain and conscious of it.

-no spinal pain.

-no orthopaedic abnormalities detected hind limbs.

-non-neurological clinical exam normal.

-ataxia present all the time, and has stayed the same since initial presentation.

RE: Case of the week: Neurology

Clive Ansell — Sat, 26 Oct 2019 11:06:36 GMT

First port of call for me, before any "testing" would be a full clinical and neurological examination.

any neurological signs other than the ataxia?

are all spinal and segmental reflexes intact?

any obvious focus of pain anywhere?

is the ataxia present all of the time, or does it come and go?

How did it progress after first presentation; worse, better, the same?

RE: Case of the week: Neurology

janine redman — Sat, 26 Oct 2019 08:27:53 GMT

Neuro exam normal? Ataxia symmetrical ? Patella test?

RE: Case of the week: Neurology

Kate Richardson — Sat, 26 Oct 2019 07:03:26 GMT

Where did the puppy come from?

RE: Case of the week: Neurology

Nicola Cole — Sat, 26 Oct 2019 06:27:42 GMT

-no known scavenging, typical into everything puppy.

-no known trauma and no bangs/yelps in the night.

RE: Case of the week: Neurology

janine redman — Sat, 26 Oct 2019 00:11:07 GMT

Any known scavenging history or toxins

any trauma or injury

RE: Case of the week: Neurology

Nicola Cole — Fri, 25 Oct 2019 23:12:41 GMT

Sorry-wanted to leave it broad so it doesn’t funnel discussion too quickly!

Owner reported normal puppy until noticed ‘walking funnily’ that morning when got up.

Eating/drinking normally.

BAR.

HR, RR, muc mems, temp, abdo all normal.

Bilateral hindlimb ataxia.

Mentation normal.

Will leave it there for now.

So:

-Any specific history to help?

-Specifics of clinical exam that would help differentials?

-Any tests you want to do?

RE: Case of the week: Neurology

Rob Loxley — Fri, 25 Oct 2019 22:24:09 GMT

damnitv?

we might need a little clue - clinical exam findings for instance